Individual
DR. JASON ALAN FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2410 SAMPSON ST, BLDG. 237, GREAT LAKES, IL 60088-2942
(847) 688-3331
Mailing address
419 EUCALYPTUS DR, REDLANDS, CA 92373-7126
(909) 709-6932
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61748
CA
Other
Enumeration date
08/16/2012
Last updated
08/16/2012
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